Hematologic Oncology Update, Issue 1, 2016 (Video Program)Viewpoint on efficacy and long-term outcomes with fludarabine/cyclophosphamide/rituximab (FCR) versus bendamustine/rituximab (BR) for patients with previously untreated advanced chronic lymphocytic leukemia (CLL)
2:28 minutes.
TRANSCRIPTION:
DR LEONARD: I find that kind of hard to nail down, because I think that you look at the curves and you look out 10 years in the curves and you see, I would say, somewhere in the range of about 20% or so of people in some subgroups with FCR seem to be doing well in some of the MD Anderson data. The question, I would say, is really, what’s the denominator there? The idea that a young person is going to go another 50 years and not relapse for CLL I think is pretty unlikely. And I honestly am fairly skeptical of that. I think once you get out 10 years, how hard are you looking for disease? Are you doing bone marrows? Are you doing MRD assessment? If you really looked at that person who got FCR who hasn’t relapsed at 10 years, are you going to find something if you look really hard? And I’m not convinced that that is either necessary but also to really prove the point that you’re theoretically curing somebody. DR LOVE: Maybe at a more practical level, what would you estimate for a patient like this, the chance might be that 5 years later they won’t require any therapy whether they’re cured or not? DR LEONARD: Yes. I think the data from the German randomized trial with both BR and FCR is you’re getting out in the ballpark of 4 to 5 years or so. And so that’s what I would say for the average person as far as a progression-free survival. Now, not requiring therapy, as you know, just because they relapse. So I would say that those people who progress could obviously go a year or two or longer and not needing treatment. DR LOVE: And I am curious, though, because it’s interesting to kind of get this flavor from you, because most people looked at that data from the German trial that was presented a year-plus ago and came away thinking that FCR was substantially better. But you kind of seem like maybe not quite so convinced that it’s that much different. DR LEONARD: The PFS differences were within 6 months or so. So and a guy who you’re hoping he’s going to live another 30 or 40 years with new therapies in CLL. Does 6 months really make a difference? There is some element of MDS and other things with FCR in a young guy. There is more infection, not that he can’t get it. So I think it’s kind of a wash, honestly. |